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HPI

A 23-year-old male collegiate soccer player presents to the clinic one day after he fell on his left wrist. He noticed immediate pain in the wrist with radiation into the thumb, index, and long finger. There is associated numbness and tingling in the median nerve distribution. The patient had not sought medical attention prior to his presentation to the clinic.

PMH

None

PE

A focused physical exam is significant for diffuse swelling at the wrist with a poor tolerance for range of motion due to pain. Diffuse tenderness over the dorsal and volar radiocarpal joint. There is diminished 2-point discrimination (> 5 mm) in the thumb, index, and long finger. He is unable to oppose the thumb due to pain. There is a brisk capillary refill in all of his digits.

Poll
1 of 9
1. In addition to standard wrist radiographs, would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
50%
457/914
Yes - additional radiographic views (aXR)
1%
12/914
Yes - CT scan
32%
297/914
Yes - MRI
7%
73/914
Yes - aXR + CT
1%
12/914
Yes - aXR + MRI
0%
6/914
Yes - CT + MRI
1%
16/914
Yes - aXR + CT + MRI
0%
5/914
Outside my area of expertise - best if I don't vote
3%
36/914
2. Would you use a classification system to guide treatment?
No - a classification system would not help me
50%
428/841
Yes - Herzberg
5%
48/841
Yes - Mayfield
28%
242/841
Yes - Other
0%
7/841
Outside my area of expertise - best if I don't vote
13%
116/841
3. How would you manage this patient?
Nonoperative (reduction and immobilization)
18%
164/868
Operative
78%
681/868
Outside my area of expertise - best if I don't vote
2%
23/868
4. If you choose Operative management, what procedure would you perform?
I would not choose Operative management
2%
21/852
Closed reduction and external fixation (ExFix)
4%
39/852
Closed reduction percutaneous pinning (CRPP)
45%
388/852
Planned open reduction internal fixation (ORIF)
42%
358/852
Proximal row carpectomy
0%
5/852
Wrist arthrodesis
0%
4/852
Outside my area of expertise - best if I dont vote
4%
37/852
5. If you choose Operative management, would you also perform a carpal tunnel release?
I would not choose Operative management
1%
12/826
Yes
74%
618/826
No
19%
164/826
Outside my area of expertise - best if I dont vote
3%
32/826
6. If you choose Planned Open Reduction Internal Fixation (ORIF), what approach would you use?
I would not choose planned ORIF
8%
65/799
Volar
39%
312/799
Dorsal
18%
148/799
Volar + Dorsal
28%
230/799
Outside my area of expertise - best if I dont vote
5%
44/799
7. If you choose Planned Open Reduction Internal Fixation (ORIF), what implant(s) would you choose?
I would not choose planned ORIF
5%
44/773
Screw(s) only
1%
15/773
K-wire(s) only
50%
394/773
Anchor(s) only
5%
46/773
Screw(s) + k-wires
5%
42/773
Screw(s) + k-wires + anchor(s)
24%
187/773
Outside my area of expertise - best if I dont vote
5%
45/773
8. If you choose Operative management and attained the construct shown below, how would you immobilize the patient postoperatively?
I would not choose Operative management
0%
5/731
Splint (thumb free)
24%
180/731
Splint (thumb immobilized)
27%
201/731
Cast (thumb free)
23%
170/731
Cast (thumb immobilized)
19%
141/731
Soft dressing
0%
6/731
Outside my area of expertise - best if I don't vote
3%
28/731
9. If you choose Operative management and attained the construct shown below, how long would you immobilize the patient postoperatively?
I would not choose Operative management
0%
5/730
No immobilization is needed postoperatively
0%
1/730
1-3 weeks
10%
77/730
4-6 weeks
64%
471/730
7-9 weeks
17%
128/730
>9 weeks
3%
26/730
Outside my area of expertise - best if I don't vote
3%
22/730
PROCEDURE #1

Left wrist open reduction internal fixation through volar and dorsal approach, repair of scapholunate ligament, and open carpal tunnel release.

Intra-procedure P1
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OUTCOMES
Post-procedure P1
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